Kilbraur Wind Farm Community Benefit Trust Fund

The Application ForM

It is important that you read the notes before you complete this application form

About your group

1. Name of group or person

Name of main contact in the group

TitleFirst nameSurname

Post held

Address for correspondence

Postcode Are you a permanent resident within the Parish of Ellingham?

Tel Fax

Email

Have you made a previous application to the Trust Fund?Yes/No

If ‘Yes’ please tell us the Reference Number(s) of the previous application(s)

About this grant

1. What does your organisation do? (refer to guidelines – Question 2)

1. What does your organisation want to do with the grant from the Trust Fund? (refer to Guidelines – Question 3). Please demonstrate need for the funding.

a) Please explain how your proposal will benefit the number of people identified:

1. Please give a detailed breakdown of all the costs. It is necessary to make sure you support these costs with quotes, estimates or catalogue pages, planning and other statutory consents and landowner agreements. (It is important that you read all the guidelines in Question 4 before completing this section.)

1. How many people are involved with your group? (refer to Guidelines – Q6)

Committee MembersVolunteersPaid StaffTotal Membership

1. How many people will benefit from this project? (refer to Guidelines – Q7)

Signature on behalf of the organisation or individual

I confirm that to the best of my knowledge and belief all replies given on this application form are true and accurate. I agree to provide additional supporting information as required by Ellingham Community Trust. I further confirm that this application is made on the basis that if successful, then I/the organisation agrees to the following conditions:

Use the grant only for the purpose agreed in the offer letter

Complete an End of Project Report as requested

Agree to any additional monitoring as required

In the event that your group was to close within twelve months from receipt of a grant any assets purchased with this grant will be given, or transferred back to Ellingham Community Trust.

Signed: ………………………………………………………………………………………….

Print Name (in capital letters): ………...………………………………. Date:……………

Data Protection Act 1998

The information given will be entered and processed on computer by the Trustees of the Ellingham Community Trust; the forms will also be kept. The information will be used by the Trustees for administration purposes of the grant scheme. Personal data is limited to contact names, position, address, telephone and other contact numbers, organisation and project; it may be considered as sensitive personal data where the organisation/project is involved with matters relating to race, ethnic origins, politics, religions or similar beliefs, physical, mental health or sexual life.

Contact details will only be disclosed to third parties for the following purposes; to enable the Trustees to process your application; to announce successful projects and to promote the Ellingham Community Trust Fund generally via press releases and other bona fide promotional activities including placement on the Ellingham Community Benefit Trust Fund Website.

Please sign to show that that you agree to the Trustees using your data in this way.

I agree to the use of my data and I confirm that to the best of my knowledge and belief all replies given on this application form are true and accurate.

Signed by the Contact Person: …………………………………. Date: …………………

Print Name: …………………………………………………………………………………….

Please make sure that you send this form back to us fully completed and that you have verified your enclosures against the checklist.

1. I/We have enclosed the following documentation:

Part or all of the information you provide us with will be held on a computer. This information will be used for the administration of applications and grants and for producing statistics. Ellingham Community Trust reserve the right to publicise details of grants awarded.

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